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Thursday, October 18, 2012

Death Panels are HERE

Today while working my shift in the emergency room, an old lady was brought in very sick and in fact near death. I did my usual workup and evaluation and attempted to administer life saving treatment. It was my plan to admit this woman to the hospital. I found out a little later that this same woman had been a patient here just slightly more than 2 weeks ago with a DIFFERENT DIAGNOSIS. I was told that if this woman was admitted, the hospital would not be paid.

The new Medicare rule now is that if the same Medicare patient is re-admitted to the hospital within 30 days, the hospital will not be paid. When they first started this nonsense they said this only applied to patients with the same diagnosis. Now they have "expanded" the rule to include re-admissions for any reason. So if you're in the hospital for pneumonia, and 3 weeks later, you break your leg.......too bad. Medicare will not pay the hospital to fix your leg.

A little later a man was brought in by ambulance, very sick, in pain, and near death. I did my usual evaluation and treatment, doing my best to ease pain and stabilize this man's illness. He needed to be admitted. To my chagrin I found out that he had been treated for the SAME problem at a DIFFERENT HOSPITAL about 10 days prior. If I admitted this man, our hospital would be paid nothing. I admitted the man.

My friends I am caught in a terrible position. I could have given treatment to both of these people and sent them out. There is no doubt that both of them would have died. Oh, I could also be sued for malpractice, but nobody cares about that. That's why we have insurance, right? 

My other choice is to admit the person, knowing full well that the hospital will have to absorb the cost of care without hope of remuneration. 

This is the climate we as healthcare providers find ourselves in today. How many small and struggling hospitals will survive under such ludicrous payment schemes? Indeed many facilities will close their doors. Many doctors will retire early or simply go do something else. As more and more are added to the Obamacare rolls, there will be less and less access. People will get sicker and yes, people will die because of it.

I had a sick and sinking feeling in the pit of my stomach today after both of these incidents. We have a good hospital. Our nurses, technicians, and support staff work very hard and they deserve to be paid for their efforts. I am not so worried about myself as I am near retirement, but I worry for all the younger folks in the healthcare business and I worry about our seniors who are in the long run going to be sacrificed as the government implements cost cutting shenanigans to cover up their broken promise made way back in 1964.

Folks, this is a nightmare!


  1. http://righttruth.typepad.com/right_truth/2012/10/death-panels-are-here.html

  2. You need to get this blog to Governor Romney today if you can and ask for a response. If he is elected, he will repeal Obama-care the day he is inaugurated. The backlash will cause quite a stir immediately. HHS should be shut down until after the election.

  3. I'm furious! And posting this at Monkey in the Middle and other fine blogs.

  4. It would be nice to blame all of this on Obama and hope that it would disappear if Obamacare is repealed, but the fact of the matter is that this has been coming way before Obamacare. It is the fault of both political parties. I doubt most of the politicians in congress realize the real time ramifications of their actions and the layers of bureaucracy perpetrated by HHS that pervert and distort the original intent of any laws they may have passed. A while back, our congresswoman, Marsha Blackburn, visited our facility in person. These issues were brought to her attention. I was not there but I was given the impression that the gravity of the situation did not sink in with her and even if it did, she's just one voice out of 435. It would be nice to think a president Romney would fix this but I fear the odds of this are non-existent to none.

    1. I used to think Marsha Blackburn wason the right side of history, but shortly after she took office I quickly realized she is just another politician. Bob Corker is just as bad as Blackburn.
      I hate to ask but, where did TN. go. It seems to have disappeared with the election of Bill Clinton. TN. has become another WI. or MN.

    2. I live half the year in London and half in NYC. I wish Americans could experience the NHS in England. A single payer socialized system that works. Not perfect of course but everyone gets a decent level of care regardless of income. And they do it for half the cost..8% of GDP vs our 16% of GDP.

    3. Nerdbird, I am oh so glad you have found your healthcare niche. Unfortunately for every anecdote like yours we can probably find 10 horror stories about Britain's healthcare system.

      I for one choose to have the gubment stay out of my business, healthcare included.

      As I have said before, Obamacare never was about healthcare, it is about CONTROL.

    4. I have and do experience socialized healthcare. It is called the VA and it is the worst healthcare one can receive. If I could afford private healthcare, I would jump at the chance.

      I know too many people over 45 who are forced into the NHS. Denial of care is big. Shortage of doctors causes the government to import doctors from 3rd World nations (Pakistan is the biggest supplier of doctors.) and rationing of necessary operations. This is also happening in Canada. Canadians can run to the US for treatment.

      Nerdbird you must be in your 20's. Wait until you are in your 60's and then tell me if you are still happy with the NHS or will you wait until you live in NYC (BTW I was born and raised in NYC.) to get treatment.

    5. I am a researcher and Canadian physicans try to get their patients in clnical trials to receive free of charge medications and/or treatments. A physican explained for a diabetic patient that received off loading foot wear within the trial was the best. The Canadian Health System intervention # 1, needed to be the less expensive option for off loading the foot with wounds. # 2, Canadian intervention was casting the foot with result of not receiving proper wound care.Final option = The patient was then forced to make a decision to allow amputation due to the previous 2 options leading to the final option. All about the cheapest way to handle a diabetic foot wound. Well, this was back in 2004, so I totoally believe this has evolved into the death panel, without anyone realizing it is happening.

    6. Can you explain to me why my friend has gone without a primary physician for 5 years now and was told that she would have another 5 years to wait?

      Socialized Medicine at its best I see.

  5. Aren't they also fining hospitals now for readmissions?

    1. Yes, they are fining hospitals. They are using any excuse to withhold or take back payments.

    2. Are prisons reimbursed if they admit someone to the infirmary more than once a month or this rule just for private citizens?

  6. Hmmm. Two months ago I went into our local ER with an increasingly bad cough. Turned out to be bronchitis. A couple of weeks later I walked back in and informed the nurse that 45 minutes prior to that I had a very sharp, strong pain in my upper chest. I didn't know ER personnel could move that fast. Turned out to be a muscle spasm but everyone told me (as I repeatedly stated the pain had left as soon as it happened, so what was the fuss about?) it was better to be safe than sorry.

    I'm not on Medicare yet, that happens in a few more years. Guess I'd better not get too sick too often after that.

    Thanks for the heads up Doc.

  7. Beyond shameful!

    In fact, denying care in some of these circumstances is nothing less than murder.

    I don't blame the hospitals and the doctors, however. I blame the government.

  8. Grouch, excellent essay. We need to Repeal ObamaCare and empower patients with price transparency, product transparency, and more control over their healthcare dollars. In fact if would follow the recommendations of economists Thomas Sowell, Walter E. Williams, and John C. Goodman, we could actually fix healthcare and our entire economy.

    1. @Dr. Hennenfent

      Do you also know if CMS has refused to pay for readmission for a *different* diagnosis within 30 days? The doctors in my clinic disagree that this is true.

      Any websites to cite would be greatly appreciated.

  9. @Subvet, better hurry, they may raise the Medicare age to 95.

    @AOW, Being in healthcare these days is another form of slavery. What else would you call forcing us to work for others for free? So much for the 13th Amendment.

    @Bradley, Yes indeed. Walter E. Williams is one of my special favorites.

  10. findalis posted at my place. I'm putting it o FB. While some of us know this is actually happening today, most do not. It carries more weight when the voice is the physician.


    By Sharon Sebastian
    Website: www.DarwinsRacists.com


    Right Truth

  12. http://www.therightplanet.com/2012/10/death-panels-are-here/

  13. Are you referring to Medicare's new denial policy for certain Hospital Acquired Conditions, (HACs ) which are infections and complications that patients didn't have when they entered the hospital, and shouldn't happen if they received excellent care. Medicare will not pay for readmissions within 30 days for HACs because the hospital caused (directly or indirectly) the condition, so they will have to treat without additional payment.

    1. No, he isn't. This is a separate issue.

    2. Dawn: I am aware of the hospital acquired condition thing, but no, I'm not talking about that. We have been told that if a Medicare patient is readmitted within 30 days for any reason, subsequent admissions will be COVERED UNDER THE FIRST DRG, which translated means the hospital won't be paid for any admission after the first. We've also been advised that this is the case even if the first admission occurred at another hospital. By the way I do not necessarily accept your assertion that a patient gets a hospital acquired infection because they did not get excellent care. I've done this for 32 years. Even under the best of circumstances, patients sometimes get infections in the hospital. The worst and most aggressive bacteria are found in hospitals due to years of acquired antibiotic resistance. There will always be hospital acquired infections. It is a fact of life. We do our best to try and prevent them.

    3. From what i have been told and read, is that this is not for life threatening situations. But insted to stop the patients that are using the ER's as a doctor office and its to make the patient accountable for their own care. My family member is a director of a county run hospital in buffalo ny and i had him read ur blig lasy night at a wedding. He claims that after reading ur blog info that ur hospital billing and admissions people are misinformed. He also said that this is also a new medicaid rule and is done to save the money on none emergency visits that r being done in the Er, like childrens ear infections, stitch or cast removal, people going in for sniffles or a cold that they have had for 3 days and could have easly gone to their primary doctor or clinic for insted of costing medicare/medicaid 4 to ten times as much for the same treatment in the ER. He also said that hospitals were promised that local health clinics that r open 24 hrs a day were supposed to be set up to direct these people to for none life threating problems along with advertising to let people know about them...but that this hasnt happened and was the main reasons that the larger hospitals were backing obamacare, knowing that all would still be taken care of.

      I am not trying to defend obama/obamacare....i hope and pray that romney wins and repeals this. I am 43 yrs old im currently on medicare after a drunk driver distroyed my life and left me in a wheelchair due to spinal cord injury and my cerabelum that shifted and is now laying hearniating my brain stem and blocking csf flow.. and because of the changes to obama careand the fact i live in pa and my doctirs and surgeons are out of state, im being told that as of 2013/2014 changes kicking in that i will be forced to see local doctors in my little hick town that give me a blank stare and say, ur case is more conplicated than i can care for...when i have met with most of the local doctors. And every time i go to the er for a true emergency (even my recent fall where i have green stick fracture to my leg, it all gets blamed on my brain and im treated like im there for pain pillls even though my first statement is always, "im not here for pain meds". Its so bad that im afraid for a real emergency that i will just die at home because of hoe badly im treated by the uneduated er staff.

      Best example i can give is that i went to the er 6 months ago when my normal bp shot up to 227/186 and my csf fluid started pouring out of my ears as nose. The triage nurse said im going to put u down for a nose bleed, i explained the situation againand i got a blank stare and i said put me down for a neurological consult...11 hours later of laying on a gurney the whole time, i left as i was told fist that it couldnt be a csf leak even though it had a halo and after testing and than that they had no way to stop it, even though i know where the leak is and my out of state neurosurgeon told them on the phone how to stop it... and guess what they handed me at discharge a prescription for pain pills lol.

    4. I generally do not respond to anonymous comments, but in this case, none of the things mentioned in the above comment have anything to do at all with the issues of Medicare readmissions. Perhaps your family member would like to attend one of our staff meetings or the hospital board meeting and explain to the administrator, the CFO, and the members how we are misinformed and explain to us why our "contractuals" with Medicare are down due to readmissions. It should be an interesting discussion.

  14. I agree with the person who said to get it to Governor Romney for a TV ad

  15. I don't know if you will let me comment or not, but I will try anyway. I screamed at the top of my lungs when congress was having the debates on obamacare about how it had nothing to do with the peoples health, but a takeover of your health. The debates were a complete joke and any idea the Republicans had were shot down with cannons. I even downloaded and copied the nightmare bill and took it to my doctor and told her that she should read it or have some of her staff read it and inform her what was in it. Now I pray that Romney wins in November so he can repeal this monster, otherwise, I'm one of those that will qualify to meet the death panel of 12 nonelected bureaucrats and be denied care because I'm no longer a "productive member of society" because of my disabilities.

  16. @ Dawn: I am aware of the hospital acquired condition thing, but no, I'm not talking about that. We have been told that if a Medicare patient is readmitted within 30 days for any reason, subsequent admissions will be COVERED UNDER THE FIRST DRG, which translated means the hospital won't be paid for any admission after the first. We've also been advised that this is the case even if the first admission occurred at another hospital. By the way I do not necessarily accept your assertion that a patient gets a hospital acquired infection because they did not get excellent care. I've done this for 32 years. Even under the best of circumstances, patients sometimes get infections in the hospital. The worst and most aggressive bacteria are found in hospitals due to years of acquired antibiotic resistance. There will always be hospital acquired infections. It is a fact of life. We do our best to try and prevent them.

    @Sara: If you know how to get this to Mitt Romney's eyes, be my guest.

    @Cyndi: You are always welcome to comment at the GROUCH. Obamacare has NEVER been about healthcare, it is about CONTROL. The liberals want to control every aspect of your life. What better way to control your life than by controlling your healthcare!

    1. A simple youtube video (nothing fancy) with you looking into the camera starting with...

      "I am an ER physician and live a quiet life on the Tennessee River with my sweet wifey and my sweet puppy"

      would sweep the internet and get the attention of RightScoop, Blaze, Rush...
      and likely Romney's campaign.

      Would you consider doing this? Could I pay you?

    2. Do it Grouch. You are one of the best authorities I know on this subject. I'll Post it everywhere I can.

    3. Mtncougar and Findalis, let me think about that, write a little script so I can collect my thoughts and come up with a video. There actually a few other things I could add which would further amplify Medicare's heinous treatment of hospitals. I am actually quite good at making videos. I'll keep you posted.


    4. I am 100% disabled, 4th category (no improvement expected). I have a Medicaid Advantage plan. I had 2 wonderful surgeons do lower back surgery on me. I wound up having a 2nd major surgery a week later due to infection at/in the surgical site. I never felt like my surgeons had failed me, or hospital staff. I am in the 7th month of a 1 year expected recovery. Every month I am better than the last. I do not have to walk with a walker anymore. After the initial recuperation, I did some research on infections in hospitals. There is not a lot of useful information out there. What I did notice is that the infection rate is something that has grown over the years. I decided that it had more to do with the age of the medical center in Houston. They can remodel the hospitals until the cows come home, but the basic plumbing, electrical, vents and such do not change. Should I ever need surgery again, I will choose one of the 3 much newer hospitals in the suburbs. I honestly believe that will go a long way to prevent me from another infected surgery.
      The other possibility is this: I have taken the same medications for about 12 years. I take methotrexate which affects my immune system. I also injected myself with Humira for 6 months a couple of years ago. I got the flu and thought I would die the first 48 hours. I stopped taking the Humira, but believe I never regained my immune system to the level it was before I took it. This type of problems exists for many older patients. I too NSAIDS for 15 years before they totally tore up my stomach. So, many of us go into the hospital with low immune systems due to the drugs we take. It is a trade off - being able to have a decent quality of life, traded for a lowered immune system. I think it is wrong not to give the 2nd needed admission which would have nothing to do with ER cases for bronchitis and such. I think the best think for those of us who know we are more susceptible, think twice when your doctor tells you to stay a few more days. I know I am the one begging to go home and handle things on my own. There are many like me - we need to listen to our physicians / surgeons when they tell us we really need to get totally out of the woods before going home.

    5. Sure, Grouch -- just send your comments to the Romney campaign here:

  17. Our government is out of control with democrat liberals in charge. They all should be charged with treason. Obama should be tried and punished to max allows for treason,murder,theft,fraud.

  18. Hi Grouch,
    I am so happy to have found your blog! As an informed Conservative, I believe there is tremendous opportunity here- the impact of this information coming straight from a physician-especially an ER Doc-is certain to shock many seniors!
    I would like to ask your permission to re-post your blog or better yet, perhaps I could encourage you to post your excellent info on my site and the members can then help get this scary stuff out to the people!
    As seniors I guess we need some lessons on scheduling our strokes and heart attacks far enough apart so we can get care! OMG!

    This information needs to go viral!

    Thanks, Suzie

    1. Be my guest. Please share and repost.

  19. Anyone who would like to repost this is welcome to do so.


  20. The CEO of our small, rural hospital jumped for joy about her "improved bottom line" provided by Obamacare. Dollars surely mean more to her than patients. We, the people, our doctors and nurses need to get together and design and operate our own healthcare system, with no insurance company or government involvement. The tax dollars and premiums that go into Medicare, Medicaid, VA are consumed by "administrative costs" and diverted into the deep pockets of bureaucrat profiteers. These monies should be freed up, as they would provide excellent healthcare to the masses, were there no profit motive. Bureaucrats would no longer decide on our life or death. We have the personnel; we have the facilities; but, do we have the will to buck the big, bad government?

    I don't believe for one minute that globalist Romney will "repeal" Obamacare, as he first stated. His rhetoric has now changed to "maybe I'll tweak it a bit." That will NOT work. The agenda of Obamacare is global depopulation via elimination of the elderly, disabled, infirmed, and anyone they classify as a "useless eater!" Simple as that.

    1. Goldbug36, I'm not exactly sure how your administrator can be overjoyed. If Obamacare is fully implemented, it will become increasingly impossible for private businesses to afford health insurance for their employees. Eventually employers will dump their workers onto the gubment dole and eventually everyone will be under a single payer system with all the red tape, bureaucracy, and onerous regulations that entails. This is what Obama wants.

      As costs skyrocket due to gubment waste and inefficiency, cuts will come down to providers and hospitals in a manner similar to what we are seeing in Medicare. Nevertheless, doctors and hospitals will be required by law to treat people for little or nothing. I refer to this as "trickle down slavery".

      Tenncare is our program in Tennessee that pays for indigent care. We make about 23 cents on the dollar with Tenncare patients. It is not enough to meet our costs. Single payer Obamacare will no doubt produce similar results.

      I have many problems with Mitt Romney. I have problems with any Republican that wants to adopt Democrat ideas and claim they can do it better. If Romney wins we'll still be saddled with some form of Obamacare. They may call it something else, but it will be intrusive, wasteful, inefficient, and probably unconstitutional in spite of what the Supreme Court says.

      I'll vote for Romney. The alternative would result in the cessation of the United States as we know it. We're almost there now.

    2. We, the people, our doctors and nurses need to get together and design and operate our own healthcare system, with no insurance company or government involvement.

      Physician owned hospitals are pretty much banned under ObamaCare and existing ones cannot expand.

    3. There's an idiot out in California named Fortney Pete Stark who has pretty much ruined the notion of physician owned healthcare facilities.

      Did you know that it is actually ILLEGAL for me to treat someone for free?

      We used to call it a courtesy. Stark calls it fraud and abuse.

      Frankly, I think it is none of his damned business.

    4. This comment has been removed by the author.

  21. I'm an ER doctor in Missouri, and I declare bullshit with a thread bare of truth. Medicare has said that they will not pay for readmission of a patient for a complication related to surgery within thirty days of discharge from the hospital. The rest is bullshit and fear mongering. Except for one final truth that you finally admitted that the medicare policy change had nothing to do with Obamacare. This is per news from the AMA.

    1. ER doc in Missouri, I would invite you to one of our staff meetings or our board meetings to explain to our administrator, CFO, and board members your alleged bullshit. You can also explain the red ink due to non payment and the CMS advisories declaring they will cover ALL less than 30 day re-admissions under the first DRG, not to mention the up to 125000 dollar fines levied against hospitals that readmit Medicare patients within 30 days.

      Thanks for the comment and thanks for exercising your first amendment rights. I will never stand in the way of an Obama supporter making a fool of himself.

    2. For that matter, how can you justify non-payment for surgical complications? Even the best of surgeons under the best of circumstances can have patients with complications. A complication does not mean the surgeon or the hospital is bad or has done anything wrong. If this were the case, plaintiff's attorneys would win 100 percent of the time.

    3. Oh, by the way, the AMA is comprised of a bunch of liberals. They don't speak for me or the majority of doctors in this country. If you pay dues to them, you're a misguided fool.

  22. Grouch, we don't live outside your state. Can you recommend a way in which to get people to see that this is true and not propaganda? Is there some concrete solid proof that people would not be able to deny or argue with? I have been trying to get some of my loved ones to wake up see reality about this situation among others.

    A side note: What are you thoughts on Gary Johnson or any of the other 3rd party candidates, have you not considered any of them? I ask because Americans are so convinced that we only have 2 choices EVERY election and look at where it has gotten us. We ALL need to start looking at 3rd party candidates much more seriously and not allow ourselves to be brainwashed by mainstream media and our GOV into thinking that we only have 2 choices who are most likely handpicked by TPTB.

    1. Correction * We live outside your state.

    2. Venusgirl, If you're talking about liberals, you may be wasting your time. They tend to ignore facts and common sense.

      A vote for a 3rd party candidate is a vote for Obama. Hold your nose and vote for Mitt.

  23. In 1967 I gave birth to a son. The doctor bill was $100, and the hospital bill for both me and my son for 4 days in the hospital was $150. Three years later I had a daughter. Dr charged $125 and the hospital had gone up too, to $207, for 3 days care. This was just after Medicare came on the scene. And fees and charges have done nothing but skyrocket ever since!!! I contend that if everybody paid their own bills, the cost would plummet. It is because we have to provide health care for every illegal and every lazy good-for-nothing welfare leech that the cost is so high for those who try to be honest and hard working and pay their "fair share". But that is not enough for oBlamer, he wants us to die. He is transitioning so many into his "entitlement" sector that now he wants to start killing off the golden oldies, of which I am now one. I don't take kindly to being told I am now a worthless person and deserve to die and get out of the way of this narcissistic, foreign- born, America-hating, pro-baby murder, anti- Christian, anti family, pro-homosexual Muslim communist so-called president. Ask me what I really think!!!!

    1. Hopefully, you will not mind if I add the terms socialist/communist/marxist/islamofascist just to make sure all the bases are covered.

      Also, sources in Chicago’s gay community report that Obama was attracted to Man’s Country’s older white clientele because he generally enjoys being fellated by older white men. Obama would regularly be seen at Man’s Country on Wednesdays. It was known as Whip It Out Wednesday in Barry's gay circles. One can google “Mans Country in Chicago”.

  24. A friend of mine recieved physical therapy. her therapist called and said don,t come in. Your medicade dosn't cover it any more and, they have made it retroactive. He had 3 other patients in the same shape. Who now owe thousands of dollars.

  25. my long post disappeared..
    My elderly mother went thru the nightmare of services denied while undergoing treatment for cancer and her decline into hospice and eventually death. Many of the medical decisions were made by "case managers" who never even met her. Don't let anyone fool you, the panels are already here.

  26. Dr. Bill Deagle is a retired ER doc exposing death panels and more. He got inside papers from WHO on population culling, held Q clearance on military bases, and met inner planners from FEMA, CDC, etc. Nutrimedical.com is the site, podcasts,

    Meanwhile read "AIDS: The Crime Beyond Belief"

    Scott died but interviews live online. They entertain in a macabre way. He was a decorated World War 2 vet who lived through the era which produced AIDS. Medical docs way back in 1969 were told the big plan.

    You listen to Lush Bimbo? That presstitute was bought long ago, says a listener.

  27. Can anyone provide chapter and verse of these alleged policies that nix payment for readmissions? I'm arguing with some libs who don't believe it, and they keep splattering me with B.S. links that talk about everything but, citing them as proof there ain't no such thing. I need the actual rules in writing (not that they would believe it even then).

    1. I would like a confirmation of this new policy as well. I shared the post with four doctors from my clinic (I'm a pharmacist) and they all said that it was inaccurate. I need confirmation that this is a real policy change.

  28. Followup:

    My initial information came through our hospital who claimed to have gotten it from CMS. The DON and I did some more checking and the following is apparently the case, at least this week:

    As far as redmissions within 30 days for the same diagnosis and readmissions for complications since the first admission, we'll be paid under the first DRG (not paid). If hospital's readmit "too many patients" (not clear to me the definition of "too many"", Medicare will withhold 1 percent of the hospital's Medicare payment across the board. This is supposed to increase to 3 percent by 2015. Nationwide this will average about $125,000 lost per hospital. We figured that this might cost us even more than if they just didn't pay us anything for the particular admission. The result is the same. Our hospital and most others is going to lose enormous amounts of money over something we cannot control.



  29. I wandered across this claim (and by link, your blog) as I perused the right-wing blogosphere. Since I am not in the medical profession and have no direct experience with Medicare billing, I was forced to rely on my finely-attuned bullshit detector, and the magic of Google, to determine that your claims are most likely incorrect.

    I have provided for you some information to ease your fears (and maybe educate your hospital administrators, though they may be using the time-honored management technique of "fear by misinformation").

    The procedures for reviewing readmissions claims are outlined in the following manual:


    Notice the direct link to CMS. Also notice the revision date of the appropriate section:

    4240 - Readmission Review - (Rev. 2, 07-11-03)

    Unless someone has a time machine laying about, I am going to venture a guess that the current president, "ObamaCare", or whatever other Faux-rage trigger you care to lay blame on, isn't at fault here.

    Now let's get to the important text:

    C. Denials -- Deny readmissions under the following circumstances:
    - If the readmission was medically unnecessary;
    - If the readmission resulted from a premature discharge from the same hospital; or
    - If the readmission was a result of circumvention of PPS by the same hospital (See

    I'd summarize those three criteria as, "you screwed up", "you really screwed up", and "you intentionally screwed up in an attempt to defraud the system". Sounds like reasonable criteria for denying reimbursement.

    Now, I don't know how your state QIO handles individual case reviews; maybe they've received direction to do more comprehensive reviews, and that's what's scared your administrators. Or maybe they're just taking a page from the Koch brothers tactic of "vote for Romney or get fired" that seems to be all the rage these days.

    The separate "Readmission Avoidance Program" implemented by the ACA penalizes hospitals for re-admitting patients at a rate higher than the national average. While it may seem scary, what the CMS is telling you is, "don't be a below average hospital." Does your hospital strive to be below average? I personally think that government, as a "customer" of these hospitals, should have the power to incent hospitals to improve their level of care.

  30. Parabens pela estrutura e conteudo de seu blog, Forte abraço Renato Artesanato em MDF

  31. October 1, 2012 7:17 PM
    Medicare change tries to limit hospital visits
    By Anna Werner
    (CBS News) A little known piece of the Affordable Care Act went into effect Monday. It is designed to lower the cost of Medicare to taxpayers.

    Hospitals will now face big fines if too many of their patients have to be readmitted because of complications. One of every five Medicare patients ends up back in the hospital within 30 days of being released.

    Roughly two-thirds of those receiving Medicare will forfeit money, up to one percent of a hospital's Medicare reimbursements.

    Phil Eklof, 84, suffers from congestive heart failure and diabetes, and wound up in the hospital twice this year. He left with a laundry list of follow-up instructions and medications.

    Eklof is fortunate. He has a home health care worker to help him.

    "If you don't take a service like this you'll end up back in the hospital," Eklof said.

    Issue brief: Health care
    Analysts: 6M to be penalized under new health law
    Federal officials are concerned that many Medicare patients nationwide fail to get the necessary follow-up care and many end up being re-admitted to the hospital, often in the same month.

    The government is now penalizing hospitals for excessive readmissions in three areas: Patients recovering from heart failure, heart attacks or pneumonia. If a released patient comes back within 30 days, there's a one-percent penalty.

    For example, if a hospital submits a $100,000 bill to Medicare, the penalty would reduce the reimbursement to $99,000.

    In all, the penalized hospitals will forfeit about $290 million in Medicare funds over the next year.

    Stephen Love, who heads the Dallas-Fort Worth Hospital Council, says the penalties are unfair to hospitals that serve primarily low-income populations.

    "Hospitals that treat people in low-income areas in many cases don't have the primary care providers they need in their communities. They may not have pharmacies they need. So to coordinate that care outside the hospital is going to be very difficult," said Love, adding that much of the responsibility relies on patients themselves.

    Not all hospitals are failing to meet these guidelines. Some hospital executive told CBS News the initiative is not all bad. In fact, some of those hospitals are developing their own programs to keep people healthier once they do get home and out of the hospital.

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